Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 19910 | CA |
NPI | 1043226053 |
---|---|
Provider Name | Steven Kallman |
First Address | Los Angeles, CA 90067-2001 |
Second Address | Los Angeles, CA 90067-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |